As CT Smoking Rates Decline, County Disparities Remain

Although smoking rates in Connecticut decreased between 1996 and 2012, striking disparities persist among counties, according to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The widest gap existed between Windham County, a rural area with the state’s highest overall smoking rate (15.6 percent), and Fairfield County, one of the wealthiest regions in the country, which had the state’s lowest smoking rate (9.5 percent). About twelve percent of the state’s population smoked cigarettes in 2012.

“You’ll find lots of variations among counties even within small states like Connecticut that have successfully lowered smoking rates compared to other states in the nation,” said Ali Mokdad, professor of global health at IHME and one of the study’s authors.

The IHME study looked at smoking prevalence – the percentage of the population that smokes – between 1996 and 2012. Nationally, researchers found that a small number of highly populated counties lead the way in reducing smoking rates, while the percentage of people who smoked varied dramatically between counties and states.

Connecticut fared well on the state level, with health experts attributing the success to a combination of measures, including increased public awareness about the dangers of tobacco use, strong enforcement of rules governing tobacco sales to minors, and state Medicaid coverage for approved smoking cessation treatments.

Statewide, smoking rates declined from 18.1 percent to 12.1 percent, falling below the national average of 14 percent. Smoking rates among men dropped from 19.7 percent to 13.2 percent; smoking rates for women fell from 17.9 percent to 11.1 percent. More men smoke than women across all counties.

• Windham County had the highest smoking rates for both men (16.9 percent) and women (14.4 percent) in 2012.

• At 15.6 percent, Windham was the only county with an overall smoking rate above the national average. Smoking rates in Litchfield (13.6 percent), New Haven (13.4 percent) and Hartford (12.5 percent) counties were close to the national average and slightly above the state average.

• Fairfield County had the state’s lowest smoking rates for men (10 percent) and women (9 percent). Residents of Fairfield County experienced the greatest decline in smoking overall (17.2 percent to 9.5 percent).

Mokdad said two factors may have contributed to Fairfield County’s success – its proximity to New York, which has strong anti-tobacco laws and policies, and its ranking as the state’s wealthiest county. In contrast, Windham County encompasses a rural area in the northeast corner of the state where 11.7 percent of residents live below the federal poverty level.

“Unfortunately, there is strong relationship between poverty and people’s health,” said Mokdad. Rural counties often lag behind when it comes to lowering smoking rates because they lack the resources typically found in urban and wealthier areas, he said.

Tobacco use represents the greatest risk factor for premature death and disability in Connecticut, health experts said. Smokers are more likely to develop cardiovascular disease, lung disease, cancer, and kidney disease, the leading causes of death and disability in Connecticut. The economic impact of chronic disease to the state could reach $44.5 billion in 2023 if risk factors such as smoking aren’t addressed, they said.

Reducing the use of tobacco among children and adults is a main objective of the newly released Healthy Connecticut 2020 report from the state Department of Public Health.

State officials aim to reduce smoking among adults 18 years and older by 20 percent, while seeking a 25 percent reduction among students in grades 6 to 12. Proposed measures include advocating for legislation that would ban smoking in cars carrying children and encouraging pediatricians to talk about smoking prevention and cessation programs with parents. Connecticut’s attorney general has called on Wal-Mart to follow the CVS Caremark Corporation and cease selling tobacco products in retail stores that have pharmacies.

Connecticut is also among seven states that cover all tobacco cessation treatments for people enrolled Medicaid, the state-federal health program for the poor, according to a recent report from the U.S. Centers for Disease Control and Prevention. Nationally, Medicaid recipients are more likely to smoke than the general population and smoking-related diseases are a major contributor to increasing Medicaid costs.

States that use a combination of strategies – from smoking and advertising bans to taxation and more – are more likely to impact smoking rates, said Mokdad. Local enforcement of federal laws banning the sale, distribution and marketing of cigarettes and smokeless tobacco to kids under age 18 is crucial, as well.

“It’s difficult,” he said, “because for every $1 spent on public health, the tobacco industry spends $18.”

Mokdad hopes the county data will “empower” Connecticut residents and policy makers to work together to reduce disparities in smoking rates.

“The challenge is to bring the state’s success story to all the counties.”